Cyclo olefin polymer and copolymer medical devices

ABSTRACT

An illuminated medical system comprises a medical instrument and a light transmitting waveguide. The waveguide projects lights from a distal portion of the waveguide toward a target area. The waveguide is formed primarily of a cyclic olefin copolymer or a cyclic olefin polymer.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/191,164 (Attorney Docket No. 028638-001300US), filed Aug.13, 2008, the entire contents of which are incorporated herein byreference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The inventions described below relate generally to the field of in vivosurgical field illumination during medical and surgical procedures.

2. Background of the Invention

Illumination of body cavities for diagnosis and or therapy has beenlimited by overhead illumination. High intensity incandescent lightinghas been developed and has received limited acceptance as well assemiconductor and laser lighting, however these light sources have aheat and weight penalty associated with their use. Excessive heat cancause unwanted coagulation of blood, as well as unnecessarily heating ofa patient's body. Additionally, heat buildup can cause variouscomponents fabricated from some polymers to exceed their glasstransition temperature and deform. Heat buildup may also cause opticalproperties of various components to be compromised. Weight of someillumination systems makes them uncomfortable for an operator,especially during a lengthy procedure. Conventional light sources relyon fiber optic and similar waveguide materials to conduct light to abody cavity. Conventional waveguide materials that are suggested formedical use suffer from some of the unstable transmissioncharacteristics under extended use described above, and theirtransmission characteristics may also change when sterilized usingconventional techniques (e.g. autoclave, EtO, gamma or e-beamirradiation). Additionally, precision optical polymers have limitedmechanical properties which limits their application in medical/surgicalsituations.

Examples of conventional polymers that have traditionally been used withsome success in surgical illumination systems include acrylics such aspolymethylmethacrylate (PMMA) and polycarbonates (PC) such as Lexan®.Polycarbonate is desirable since it may be fabricated into variousconfigurations which may be slightly bent without shattering. Whilepolycarbonate has good mechanical strength and manufacturability, itsoptical properties are not optimal. For example, polycarbonate has a lowlight transmission efficiency, and therefore is not ideal fortransmitting light, especially along a long pathway. Acrylic has alsobeen used with some success in surgical illumination systems. It is moreefficient at transmitting light than polycarbonate, is easy to process(e.g. may be injection molded), but acrylic is also brittle and canshatter. Also, acrylic has a relatively low glass transitiontemperature, and thus acrylic components do not tolerate heat buildupwell, especially in medical illumination systems where heat is generatedduring use. Acrylic also absorbs moisture and this changes therefractive index of the material which can alter its performance.Therefore, it would be desirable to provide a material that is bettersuited for medical illumination systems and that has at least some ofthe desirable mechanical and optical properties of acrylic orpolycarbonate while minimizing the less desired properties. For example,such materials would preferably have equivalent or better lighttransmission efficiency than acrylic, a higher glass transitiontemperature relative to acrylic, be easy to process like acrylic orpolycarbonate, have better resistance to moisture absorption thanacrylic, and be bendable without shattering like polycarbonate.Moreover, the material used must also be able to withstand terminalsterilization without compromising optical properties. Many polymersdiscolor when irradiated or can deform due to exposure to heat duringsterilization. It would therefore also be advantageous to provide amaterial that can be terminally sterilized without damage. Also, anymaterials used in a medical application must also be biocompatible. Atleast some of these challenges will be addressed by the exemplaryembodiments disclosed below.

BRIEF SUMMARY OF THE INVENTION

The devices described below provide for surgical retraction orillumination, or both, with devices made primarily of an amorphouspolyolefin, cyclo olefin copolymer (COC) or cyclo olefin polymer (COP).While many of the embodiments described below preferably use COP, one ofskill in the art will appreciate that COC may also be used.

Preferably, a retractor formed primarily of cyclo olefin polymer is usedas the illumination device. A surgical illumination system formed ofcyclo olefin polymer may include a generally cylindrical light waveguidehaving a bore sized to accommodate one or more surgical instruments, anillumination source, an illumination conduit for conducting illuminationenergy from the illumination source, and an adapter ring for engagingthe illumination conduit and coupling illumination energy from theillumination conduit to the light waveguide. The adapter ring may permitrelative movement between the illumination conduit and the lightwaveguide.

The new illumination system may also include an illumination source, agenerally cylindrical light waveguide formed of cyclo olefin polymerhaving a distal end and a proximal end, and a bore sized to accommodateone or more instruments or tools extending from the proximal end throughthe distal end. The waveguide conducts light from the proximal end tothe distal end and projects the light from the distal end. Theillumination conduit conducts light from the light source to theproximal end of the light waveguide.

A COP illumination system may also include any suitable retractor systemsuch as McCulloch retractor, and includes a channel in the retractorblade to accommodate a COP illuminator. In this system, the COPilluminator is also formed to have an air gap surrounding any activeportion of the illuminator from the light input to the light outputportion. The illuminator has active portions in which light passes andinactive or dead zones in which light does not pass as a result of theconfiguration and orientation of the input, output and surfaces of theilluminator. The dead zones may include elements to allow theilluminator to securely engage the retractor.

The medical retractor system as described below includes a cannula,retractor or retractor blade having a cyclo olefin polymer elementextending from the proximal end thereof to the distal end thereof, alight source operably coupled to the proximal end of the cyclo olefinpolymer element, and at least one light extracting element near thedistal end of the cyclo olefin polymer element.

A COP blade insert illumination system includes one or more illuminationelements composed of cyclo olefin polymer. The COP illumination elementsoperate as a waveguide and may incorporate optical components such as,for example, symmetric or asymmetric facets, lenses, gratings, prismsand or diffusers to operate as precision optics for customized deliveryof the light energy. The illumination elements may be modular, allowingcomponents to be mixed and matched for different sizes of bladeretractors, or may be a single integrated unit. Each module may alsohave different performance characteristics such as a diffuse lightoutput or a focused light output allowing users to mix and match opticalperformance as well.

Any dissecting tools and/or retractors for small surgical sites such asthe hand or foot may be formed of COP with a light input at the proximalend to enable the distal end to illuminate the surgical site. One ormore structural elements such as wire may be co-molded into a COP toolfor increased mechanical strength. A suitable COP compound is producedby Zeon Chemicals L.P. under the trademark Zeonor® and Zeonex®. Thesetwo polymers have at least some of the mechanical characteristics and atleast some of the optical stability and characteristics for use in anilluminated medical system.

In one aspect of the present invention, an illuminated medical systemcomprises a medical instrument and a light transmitting waveguide. Thewaveguide has a proximal region and a distal region, and is coupled tothe medical instrument. The waveguide is configured to conduct lightfrom the proximal region to the distal region thereof, and the waveguideprojects the light from an extraction area preferably near the distalportion of the waveguide toward a target area. The waveguide is formedprimarily of a cyclic olefin copolymer or a cyclic olefin polymer.

The medical instrument may comprise one of a surgical retractor, alaryngoscope, a speculum, or an anoscope. Other medical instruments arealso contemplated for use. The waveguide may be adjustably positionablerelative to the medical instrument thereby allowing adjustment of theprojected light onto the target area. The waveguide may further compriseone or more output optical structures disposed adjacent the distalportion thereof. The output optical structures may be configured todirect the light from the distal portion of the waveguide to the targetarea as well as the surface of the waveguide. The output opticalstructures may comprise one or more facets. The waveguide may comprise atubular body, an elongate blade, or a half tubular body. The system mayfurther comprise an illumination source, an illumination conduit, and anoptical coupling. The illumination source may provide the light. Theillumination conduit may be optically coupled with the illuminationsource and the waveguide. The illumination conduct may be configured toconduct light from the illumination source to the waveguide. The opticalcoupling may be coupled to the waveguide and the illumination conduit.The optical coupling may be configured to optically couple theillumination conduit with the waveguide so that the light may passtherebetween. The optical coupling also may be used to releasably holdthe illumination conduit and the waveguide together.

In still another aspect of the present invention, an illuminated medicalsystem comprises a medical instrument and a light transmittingilluminator. The illuminator has a proximal region and a distal region,and is coupled to the medical instrument. The illuminator is configuredto conduct light from the proximal region to the distal region thereof,and the illuminator comprises a light input portion, a light conductingportion, and a light output portion. The light output portion projectsthe light from the distal portion of the illuminator towards a targetarea, and the light conducting portion is formed primarily of a cyclicolefin copolymer or a cyclic olefin polymer.

The light output portion may be adjustably positionable relative to themedical instrument thereby allowing adjustment of the projected lightonto the target area. The light output portion may comprise one or moreoutput optical structures disposed adjacent the distal end thereof. Theoutput optical structures may be configured to direct the light from thelight output portion to the target area. The output optical structuresmay comprise one or more facets. The light conducting portion maycomprise a tubular body, an elongate blade, or a half tubular body. Thesystem may further comprise an illumination source that provides thelight, and an illumination conduit. The illumination conduit may beoptically coupled with the light input portion and the illuminationsource, and the conduit may be configured to conduct light from theillumination source to the light input portion. An index matchingmaterial such as a liquid or gel may be used to help optically couplethe components together.

In yet another aspect of the present invention, a method forilluminating a medical work space comprises providing a medicalinstrument coupled to a light transmitting waveguide, and advancing themedical instrument and the waveguide toward the work space. The methodalso comprises illuminating the work space with light from thewaveguide. The light passes from a proximal portion of the waveguide toa distal portion of the waveguide. The waveguide is formed primarily ofa cyclic olefin copolymer or a cyclic olefin polymer.

The medical instrument may comprise one of a surgical retractor, alaryngoscope, a speculum, or an anoscope. Advancing the medicalinstrument and the waveguide may further comprise positioning themedical instrument in a patient and retracting tissue with the medicalinstrument. Advancing the medical instrument and the waveguide maycomprise positioning the medical instrument and the waveguide in a bodyorifice or into an incision. The waveguide may comprise a tubular bodyhaving a central channel, and advancing the medical instrument maycomprise positioning the medical instrument through the central channel.Illuminating may comprise adjusting the waveguide position relative tothe medical instrument, thereby adjusting illumination of the workspace. Illuminating may comprise optically coupling the waveguide withan illumination source.

In any of the embodiments disclosed herein, the waveguide or the lightconducting portion of the illuminator may have a specific gravity lessthan that of polycarbonate or acrylic. The water absorption rate of thewaveguide or the light conducting portion of the illuminator may be lessthan that of polycarbonate or acrylic. Therefore, the water absorptionrate is preferably less than 0.01%. The light transmission efficiency ofthe waveguide or light conducting portion of the illuminator may begreater than that of polycarbonate or greater than or equal to that ofacrylic. Thus, the light transmission efficiency is preferably greaterthan 90% and more preferably greater than 92%. The waveguide or thelight conducting portion of the illuminator may have a refractive indexgreater than acrylic, and the glass transition temperature thereof maybe greater than that of polycarbonate or acrylic. Thus, the refractiveindex is preferably greater than 1.49, and the glass transitiontemperature is greater than or equal to 105° C. The waveguide orilluminator is preferably biocompatible.

These and other embodiments are described in further detail in thefollowing description related to the appended drawing figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a COP blade insert illuminator.

FIG. 1A is a cross-section of the COP blade insert illuminator of FIG. 1taken along A-A.

FIG. 1B is a cross-section of the COP blade insert illuminator of FIG. 1taken along B-B.

FIG. 2 is a perspective view of an alternate COP blade insertilluminator.

FIG. 2A is a perspective view of the attachment mechanism of the COPblade illuminator of FIG. 2.

FIG. 3 is a perspective view of another COP blade insert illuminator.

FIG. 3A is a close perspective view of the light output section of theCOP blade illuminator of FIG. 3.

FIG. 3B is a close perspective view of a conduit section of the COPblade illuminator of FIG. 3.

FIG. 3C is a front view of a light ray path for a light conduit sectionof the COP blade illuminator of FIG. 3.

FIG. 4 is a perspective view of a single waveguide COP blade illuminatorwith a flexible input coupling for a short blade retractor.

FIG. 5 is a perspective view of a single waveguide COP blade illuminatorsystem with a flexible input coupling for a long blade retractor.

FIG. 5A is a perspective view of an alternate waveguide COP bladeilluminator with a rigid input coupling.

FIG. 6 is a perspective view of an alternate attachment mechanism forCOP blade insert illuminator sections.

FIG. 7 is a side view of a COP blade insert illuminator with steppedwaveguide sections.

FIG. 8 is a perspective view of an alternate single waveguide COP bladeinsert illumination system.

FIG. 9 is a perspective view of a single waveguide COP blade insert witha light directing structure.

FIG. 10 is a perspective view of a single waveguide COP blade insertwith a light directing structure with an attachment mechanism.

FIG. 11 is a perspective view of a single waveguide COP blade insertwith a waveguide element co-molded with a retracting element.

FIG. 12 is a perspective view of a COP illuminated retractor.

FIG. 12A is an exploded view of the input collar and the illuminationblade input.

FIG. 13 is a cross-section view of the COP illuminated retractor of FIG.12.

FIG. 14 is a side view of the COP illumination blade of FIG. 12.

FIG. 15 is a front view of the COP illumination blade of FIG. 12.

FIG. 16 is a side view of a COP laryngoscope cavity illuminator in use.

FIG. 17 is a side view of a COP laryngoscope illumination system with anillumination source in the blade.

FIG. 18 is a side view of a COP laryngoscope illumination system with anillumination source in the handle.

FIG. 19 is a side view of an alternate COP laryngoscope illuminatoraccording to the present disclosure.

FIG. 20 is a side view of a metal blade laryngoscope including a COPilluminator waveguide engaging the blade.

FIG. 21 is a cross section of the laryngoscope with COP illuminatorwaveguide of FIG. 20 taken along B-B.

FIG. 22 is a side view of a COP laryngoscope cavity illuminatorwaveguide.

FIG. 23 is a side view of a COP speculum illumination system.

FIG. 24 is a side view of the COP cavity illumination system of FIG. 23with the handles closed.

FIG. 25 is a side view of an alternate COP cavity illumination systemwith the illumination source in the handle.

FIG. 26 is a side view of another alternate COP cavity illuminationsystem.

FIG. 26A is a cutaway view of the COP blade of cavity illuminationsystem of FIG. 26 taken along C-C.

FIG. 26B is a cutaway view of an alternate COP blade of cavityillumination system of FIG. 26 taken along C-C.

FIG. 27 is a side view of still another alternate COP cavityillumination system.

FIG. 28 is a top view of yet another COP cavity illumination systemaccording to the present disclosure.

FIG. 29 is a cutaway view of the COP cavity illumination system of FIG.28 taken along D-D.

FIG. 30 is a perspective view of a COP optical waveguide with a curvedinput light coupling.

FIG. 31 is an enlarged perspective view of the distal end of the COPoptical waveguide of FIG. 30.

FIG. 32 is a perspective view of a COP optical waveguide with a splitinput coupling.

FIG. 33 is cutaway view of the COP optical waveguide of FIG. 32.

FIG. 34 is a cross-section of the COP optical waveguide of FIG. 32 takenalong B-B.

FIG. 35 is a perspective view of an alternate COP optical waveguide witha split input coupling.

FIG. 36 is a perspective view of another alternate COP optical waveguidewith a split input coupling.

FIG. 37 is a cross section of the distal end of a COP optical waveguide.

FIG. 38 is a cross-section of the distal end of an alternate COP opticalwaveguide.

FIG. 39 is a perspective view of an alternate COP optical waveguide witha reinforced and shielded split input coupling.

FIG. 40 is a cutaway view of the COP optical waveguide of FIG. 39.

FIG. 41 is a perspective view of the COP optical waveguide of FIG. 39with the clamp assembly removed for clarity.

FIG. 42 is a side view of the COP optical waveguide of FIG. 41.

FIG. 43 is a cutaway perspective view of a COP optical waveguide withthe clamp assembly removed for clarity.

FIG. 44 is a close up front view of the input connector of FIG. 43.

FIG. 45 is a perspective view of a separable COP waveguide.

FIG. 46 is a cutaway view of the COP optical waveguide of FIG. 45.

FIG. 47 is a cutaway view of a COP optical waveguide with an extendedreflecting surface.

DETAILED DESCRIPTION OF THE INVENTION

Cyclic olefin copolymer (COC) and cyclic olefin polymer (COP) are arelatively new class of optical polymers that have glass-like clarity,and therefore are promising materials for optical components used inilluminated medical systems. COC is an amorphous polymer produced bychain copolymerization of cyclic monomers such as8,9,10-trinorborn-2-ene (norbornene) or1,2,3,4,4a,5,8,8a-octahydro-1,4:5,8-dimethanonaphthalene(tetracyclododecene) with ethane, TOPAS Advanced Polymer's TOPAS, MitsuiChemical's APEL, or by ring-opening metathesis polymerization of variouscyclic monomers followed by hydrogenation (e.g. Japan Synthetic Rubber'sARTON, Zeon Chemical's Zeonex and Zeonor). These later materials using asingle type of monomer are more properly referred to as cyclic olefinpolymers (COP).

COC and COP have transparency similar to glass in its natural form.Therefore they may be used in optical components such as a waveguide,illuminator, or any of the components in the illuminated medical system,instead of acrylic or polycarbonate. COC and COP also have a highmoisture barrier for a clear polymer and a low absorption rate. They arerecognized to be a high purity product with low extractables and arehalogen free. While material properties will vary due to monomercontent, glass transition temperature can exceed 150° C. Moreover, whileCOC and COP may be attacked by non-polar solvents such as toluene, theynevertheless provide good chemical resistance to many other solvents.

COC and COP may be extruded, coextruded, vacuum formed, injectionmolded, and can be terminally sterilized with EtO (ethylene oxide).Sterilization by irradiation may also be performed, but the polymer maydiscolor. Many polymers may exhibit birefringence when molded. Highbirefringence can weaken the part, and can also reduce the opticalperformance of the part. It would therefore be desirable to provide apolymer such as COP or COC than can be molded with low birefringence.

Because of the desirable engineering properties of COC and COP, thesepolymers are promising for use in optical components such as in anilluminated surgical system like an illuminated retractor, laryngoscope,cannula, or the like. Use of COP will be discussed in many of theembodiments below, however, this is not intended to be limiting, and COCmay also be used instead of COP.

Exemplary COC polymers include Mitsui Chemicals, Inc. APEL™ APL5514MLand APL5014DP optical grade molding resins. Table 1 below summarizessome of the material properties of APEL™. Because this material has theminimum birefringence and highest refractive index of COC polymers, andbecause it may be processed with injection molding, it is a goodcandidate for use in optical components such as lenses or lightwaveguides.

TABLE 1 Property APL5514ML APL5014DP Heat resistance (° C.) T_(g)(Mitsui method, DSC) 135 135 TMA (Mitsui method, softening 147 147point) Melt flowability (g/10 min) 36 36 MFR (260° C., 2.16 kg) Opticalproperties Refractive index (n_(D)) 1.54 1.54 Abbe number 56 56

Other exemplary COP polymers include Zeonex® and Zeonor® cyclo olefinpolymers from Zeon Corporation (Tokyo, Japan). These COP polymers aredesirable due to their optical properties, low water absorption, andhigh purity. Water absorption is less than 0.01%. Also, Zeonex® has alow specific gravity (approximately 1), thereby allowing opticalcomponents to be fabricated that are light weight. Also, Zeonex® COP hasa relatively high heat resistance that is greater than acrylics such aspolymethylmethacrylate (PMMA) while heat resistance is similar to thatof polycarbonate (PC). COP also has excellent resistance to acidic andalkali chemicals, and is readily injection moldable. Several of themechanical properties of various grades of Zeonex® and Zeonor® aresummarized in Table 2 below. In addition to the mechanical and opticalproperties, some of the Zeonex® and Zeonor® COPs are also biocompatiblebased on testing conducted under ISO standard 10993 or under USPstandards. A drug master file (DMF) has been established by themanufacturer.

TABLE 2 Zeonex ® Zeonex ® Zeonex ® Zeonex ® Zeonex ® Zeonor ® Zeonex ®Zeonex ® Property 480 480R E48R 330R RS820 1020R 690R 790R Specificgravity 1.01 1.01 1.01 0.95 1.01 1.01 1.01 1.01 Water <0.01 <0.01 <0.01<0.01 <0.01 <0.01 <0.01 <0.01 absorption (%) Light 92 92 92 92 White 9292 92 transmittance, (%), 3 mm thickness Refractive index 1.53 1.53 1.531.51 — 1.53 1.53 1.53 Glass transition 138 138 139 123 138 105 136 163temperature, ° C. Heat distortion 123 123 122 103 123 101 136 161temperature, ° C. (18.6 kgf/square cm, no annealing) Tensile 59 59 71 4543 53 61 73 strength, MPa

Table 3 below summarizes some of the mechanical and optical propertiesof various polycarbonate (PC) and polymethylmethacrylate (PMMA)polymers.

TABLE 3 PC Optical Property Grade PC PMMA Specific gravity 1.2 1.21.17-1.2  Water absorption (%) 0.2 0.15 0.3  Light transmittance, 89 8992-95 (%), 3 mm thickness Refractive index 1.59 1.59 1.49 Glasstransition 121 123-132 74-99 temperature, ° C. Tensile strength, MPa 6367 49-77

Therefore, it would be desirable to provide a material such as COP orCOC having a specific gravity greater than polycarbonate or PMMA (so theparts are lighter), and water absorption less than polycarbonate orPMMA. Water absorption affects index of refraction, therefore Zeonex andZeonor are desirable since they are non-polar and hence hydrophobic withvery low absorption. Additionally, it would be desirable to provide amaterial such as COP or COC that transmits light with greater efficiencythan polycarbonate or greater efficiency or equal efficiency to that ofPMMA. The COP or COC material also preferably has a glass transitiontemperature greater than polycarbonate or PMMA. At least some of thegrades of COP or COC disclosed herein are also sterilizable with atleast EtO without compromising optical properties of the component.

Retractor illumination system 10 of FIG. 1 includes blade retractor 12including channel 13 to engage a fiber optic input 14 and waveguideilluminator 16. Latch 17 serves to mechanically attach waveguideilluminator 16 to fiber optic input 14 so that the resulting assemblymay be moved up and down in channel 13 to any position suitable forillumination. The optical coupling between fiber input 14 and waveguideilluminator 16 is a simple face-to-face coupling, which may be enhancedby use of an index matching gel, or other similar material, applied toeither the fiber input 14 or the waveguide illuminator 16 or both. Lightentering waveguide illuminator 16 is contained within the waveguide withminimal light loss until it reaches output optical structures such asoutput structures 18, where light exits to illuminate the predeterminedillumination area 20. Output optical structures 18 may include one ormore stair stepped facets or lenses that may include a radius or angledface, one or more prism structures, one or more diffraction gratings,applied optical film, or other optical structures designed to direct theavailable light to the predetermined illumination area 20.

In the cross-section view of FIG. 1A channels 13 of blade 12 engagewaveguide illuminator 16. Any suitable channel configuration may beused, such as, for example, a single channel with a circular or rhomboidcross-section. The section view of FIG. 1B shows a section of bladeretractor 12, waveguide illuminator 16 and fiber input 14, with detailshowing latch 17 which snaps into a hole or detent 14D formed in fiberinput 14 and the latch may be disengaged with a minor amount of force.Output optical structures 18 control and direct output light energy 21which illuminates predetermined illumination area 20.

Alternate blade insert illumination system 22 of FIG. 2 includes bladeretractor 24 that includes light input section 26, one or more lightconduit sections such as light conduit section 27, and a light outputsection such a light output section 28 that includes one or more outputoptical elements such as output optical elements 30. In thisconfiguration, light input section 26 has an integrated fiber opticinput 32. One or more fiber optic strands such as strands 32A and 32Bmay be integrated into the upper portion of light input section 26 bymolding the strands into light input section 26, gluing the strands intoa formed receiving hole 26R formed into the section, or other suitablemethods. A light coupling element such as element 33 may also beincluded to improve light coupling and distribution. A collar such ascollar 34 may be provided to aid in strain relief for the optical fiberinput. Light directing structure 36 causes the light coming into thecenter of the waveguide illuminator to be directed along the sides oflight input section 26. The same light directing structure is shown inlight conduit section 27, serving to direct the light down to the nextsection. Light input section 26 and light conduit section 27 may beprovided without the light directing structure, but this may result in adecrease in efficiency.

Output optical element 30 may have a flat face to which an opticaloutput film is applied to allow light to escape and direct the lighttoward tissues of interest, or output section 28 may have output opticalfilm or molded structures located on or integrated into rear face 28Rthat serve to send light out through output optical element 30.

FIG. 2A shows the blade insert illuminator system of FIG. 2 with lightconduit section 27 removed to show the section attachment mechanismconsisting of one or more male members such as engagement member 38 anda corresponding receptacle such as receptacle 39. Output end 38A of themale member 38 may also include one or more output transmission couplingstructures or optical structures, e.g., a lens, such as lens 38L tofocus the light into the corresponding receptacle. Bottom 39A ofreceptacle 39 may also include one or more input transmission couplingstructures or optical structures, e.g., a lens, such as lens 39L tospread light into its corresponding waveguide. In use, the male membersare pressed into the female receptacles of the subsequent section andfriction holds the sections together.

In this configuration, light conduit section 27 of FIG. 2 may beremoved, allowing light input section 26 and light output section 28 tobe directly connected together, for example, to fit a blade having ashort length or to permit adjustment along the blade retractor of thewaveguide element to adjust the location of the illumination area. Oneor more light conduit sections 27 may be added to the assembly to fitblades of medium or long length thereby providing a modular blade insertillumination system whose components may be mixed and matched as needed.For example, if more than one blade retractor is used in a procedure,one blade may be fitted with a shorter assembly of blade illuminationcomponents to illuminate the upper part of the surgical field and asecond blade may be fitted with a longer assembly of blade illuminationsystem components to illuminate the lower, deeper part of the surgicalfield. Sliding a blade insert illumination system up and down slightlywithin the blade channel allows the illumination area to be adjusted,for example, sliding the light output section closer to the work areaincreases the intensity of illumination and sliding it away from thework area provides a more diffuse, less intense illumination. In thisway, the modular blade insert illumination system may be optimized for aparticular type of work to be performed.

FIG. 3 illustrates an alternate blade insert illumination system 40inserted into blade 12. Blade insert illumination system 40 includeslight input section 40A, one or more light conduit sections such asconduit sections 40B and light output section 40C. Bifurcated fiberoptic cable 41 is integrated into light input section 40A. This bladeilluminator configuration includes an engagement arm 42 and lightdirecting structure 44.

FIGS. 3A, 3B and 3C illustrate details of arm 42 and light directingstructure 44. When two or more modular elements of blade insertilluminator system 40 engage channels 13, the engagement arm 42 of firstelement 40B engages adjacent element 40A to maintain a secure opticalconnection at interface 45 between the elements. Arm 42 is a generallyresilient member to permit flexing at joint 46 which permits tooth 47 toengage the light directing structure of the adjacent element. One ormore light control elements such as light collecting lens 48 may beincluded at the input end of each blade illuminator element such asinput end 49 of light output section 40C. Similarly, light output lens50 may be included at the bottom, exit or output end 51 of a lightconduit section such as conduit section 40B. Lenses 48 and 50 areillustrative of the use of optical structures to aid in the transmissionof light between modules. Any other suitable optical structures such asangled facets, multi-faceted lens structures, spherical or asphericallens may also be used. FIG. 3C illustrates how light travels in a bladeinsert illuminator conduit such as conduit element 40B. Light frombifurcated fiber optic cable 41 first enters the top of light inputsection 40A as illustrated in FIG. 3. Light energy 52 entering a bladeilluminator waveguide such as conduit 40B, either from the fiber opticcable or light collecting lens 48, are guided by light directingstructure 44 and light output lens 50.

Single element blade illuminator 54 is shown in FIG. 4. In this example,retractor 56 has a short blade 57. When used with a retractor having along blade, single element blade illuminator 54 may be adjusted alongthe length of the retractor blade to provide illumination wherever it isneeded.

In this configuration, a short section of fiber optic cable 58 isintegrated into blade illuminator waveguide 60 at the output end and hasany suitable connector 62 such as an industry standard ACMI connector orany other type of standard or proprietary connector, at the input end.Connector 62 is normally connected to a standard fiber optic light guidecable that conducts light from an external light source. Since bladeinsert illumination system 54 is made to minimize light loss, portableLED light sources may be attached directly to connector 62 or via a muchshorter fiber optic light guide cable. Short section of fiber opticcable 58 is flexible and allows considerable latitude in how theconnector 62 and light guide cable are oriented. For example, theconnector 62 may be placed toward handle 56H of retractor 56 or it maybe placed on either side in order to keep out of the way of the surgeonand any other equipment that may be in use.

Single element extended blade illuminator system 64 of FIG. 5 is asimple blade insert illuminator designed to fit long blade retractorssuch a retractor 66. Illuminator waveguide 68 receives light at input69, conducts light through total internal reflection throughout centerportion 68C, and output optical structures such as output structure 70directs the light toward a predetermined area to be illuminated.

FIGS. 4 and 5 illustrate that a blade insert illuminator may be providedin different sizes appropriate for the size of the retractor blade withwhich it is to be used. Blade insert illuminator 72 of FIG. 5A is anextended waveguide blade illuminator with a rigid light input component73 in the place of the short section of fiber optic cable 58 as shown inFIGS. 4 and 5. Rigid light input component 73 allows all of the lightguiding sections, waveguide 74 and rigid light input component 73, to bemolded as one device, thereby reducing cost of the assembly. Supportgussets or flanges such as flanges 75 may be added to provide stability.Flanges 75 may have a coating or film applied to prevent light fromescaping or may be made from a different material, for example, using aco-molding or overmolding process. Rigid light input component 73 mayhave an orthogonal input as shown, requiring light directing structure76 to direct light from connector 62 down to waveguide 74 of thewaveguide illuminator. Rigid light input component 73 may also be formedwith a radius, as shown in FIG. 5, and using total internal reflectionto guide the light from connector 62 to the body of the waveguide. Rigidlight input component 73 may also be made rotatable, thereby allowingthe fiber optic light guide cable to be positioned as needed around thesurgical field to avoid interference with other instruments.

FIG. 6 illustrates alternate modular blade insert illuminator elements80A and 80B showing an alternative placement of latches 82 that hold thewaveguide components together. Keeping the latches off to the side ofthe components, rather than in front as shown in FIG. 3, reduces thelikelihood of the latches being accidentally disengaged or broken bysurgical instruments during the course of a surgical procedure. Anyother suitable mechanisms may be used to attach the modular componentsto each other, e.g., dovetail joints, tongue-and-groove joints,adhesives that are preferably index matching adhesives, etc., tooptimize light coupling from one module to the next. The attachmentmechanisms may also be separate from the optical path, for example,metal pins and sockets may be located in optically inactive areas of themodules.

FIG. 7 is a side view of an alternate modular blade insert illuminationsystem 84 wherein each subsequent waveguide section is lessened inthickness 85. This allows output optical structures such as outputstructures 86 to be placed at the exposed end of the upstream waveguide,thereby allowing light to be directed from each waveguide section suchas sections 84A, 84B, 84C. Each waveguide component such as sections84A, 84B may have a bottom surface that contains output opticalstructures 86 over much of its surface to act as a terminal illuminationcomponent in case no other subsequent waveguide components are attached.Light output section 84C shows stepped output optical structure 88 onthe front side and output optical structures 89 on the back side.Without output optical structures 88 that direct light out of the face,light would be lost out the end of light output section 84C, therefore,the combination of output optical structures 88 and 89 contribute tohigher efficiency through less lost light.

Referring now to FIG. 8, winged blade insert illuminator 90 is shownengaged to retractor 91. Illuminator 90 has integrated wings 92 that mayserve an additional retracting function. Wings 92 are oriented generallyparallel to long axis 87 of illuminator 90. In this configuration, lightis directed to exit output optical structure 94. Light entersilluminator 90 via light input component 95, which may be a fiber opticcomponent or a rigid light conducting component at previously discussed.Because total internal reflection may allow light to enter wings 92, thewings may need a reflective coating to prevent light from exiting thewings and being lost or shining into unwanted directions, such as backinto the surgeons eyes.

FIG. 9 illustrates another alternate blade insert illuminator 90A thathas a light directing element 96, which serves to direct the lightcoming into the middle of the illuminator out toward the wings 92A.Output optical structures such as structures 97 and 98 may be placed onwings 92A and body respectively to provide illumination from bothstructures as shown by the arrows.

FIG. 10 illustrates another alternate blade insert illuminator 90B withan extended light directing element 96B. In this embodiment, opticaloutput structures are placed only on the wings 92B so that illumination,light energy 99, only exits through extended output structures 97B inwings 92B as shown by the arrows. Extended light directing element 96Bhas reflective walls such as wall 93 that extend to output end 90E ofilluminator 90B to maximize light reflected to the wings 92B. Thisconfiguration also includes alternative latch arm 100 oriented near theinterface with retractor 102 to engage cutouts or detents such asdetents 103A, 103B and 103C located in retractor 102. Latch arm 100maybe made of the same material as the waveguide or may be made of adifferent material for durability. For example, latch arm 100 may bemade from steel or titanium and insert molded into illuminator 90B.

Alternatively, a retractor blade may be inserted into one or more slotsin the illuminator waveguide to provide rigidity and or to enablecooperation with surgical site retention apparatus.

Co-molded blade insert illuminator 104 of FIG. 11 includes waveguidesection 106 has been co-molded or over-molded with wing and bodyretractor portions 104W and 104B respectively, which are made of adifferent material. For example, retractor wing and body portions 104Wand 104B may be made of a stronger, glass reinforced plastic or steel ortitanium for strength while waveguide section 106 is molded from cycloolefin polymer.

FIG. 12 illustrates a McCulloch style retractor adapted to provide lightinto the surgical field. Illuminated retractor 107 is composed ofretractor blade 108 and illumination blade 109. Retractor blade 108 isshown as a McCulloch style retractor blade for use with a McCullochretraction system although any suitable retractor and or retractionconfiguration may be used. Retractor blade 108 includes one or moremechanical connectors such a mechanical connector 108M and neck slot orchannel 110 to accommodate neck zone 124 and blade slot 111 toaccommodate output blade 125 within retractor blade 108 whilemaintaining an air gap between active zones of the illumination bladeand the retractor. Two or more engagement elements such as blade orplate 112 and tabs 114 secure illumination blade 109 to retractor blade108. Each tab 114 engages one or more engagement receptacles such asreceptacles or recesses 115. Plate 112 is joined to collar 116, and whencollar 116 removably engages input dead zone 122D, the collar surroundsillumination blade input 118. The removable engagement of collar 116 toinput dead zone 122D also brings plate 112 into contact with end surface119 of the retractor blade. Collar 116 securely engages dead zone 122Dand surrounds cylindrical input zone 120 and forms input air gap 120G.Engagement at dead zones minimizes interference with the light path byengagement elements such a plate 112 and tabs 114. Plate 112 engages endsurface 119 and tabs 114 resiliently engage recesses 115 to holdillumination blade 109 fixed to retractor blade 108 without contactbetween active zones of illumination blade 109 and any part of retractorblade 108.

Illumination blade 109 is configured to form a series of active zones tocontrol and conduct light from illumination blade input 118 of thecylindrical input zone 120 to one or more output zones such as outputzones 127 through and output end 133 as illustrated in FIGS. 12, 13, 14and 15. Illumination blade 109 also includes one or more dead zones suchas zones 122D, 126D and 126E. Dead zones are oriented to minimize lightentering the dead zone and thus potentially exiting in an unintendeddirection. As there is minimal light in or transiting dead zones theyare ideal locations for engagement elements to secure the illuminationblade to the retractor.

Light is delivered to illumination blade input 118 using anyconventional mechanism such as a standard ACMI connector having a 0.5 mmgap between the end of the fiber bundle and illumination blade input118, which is 4.2 mm diameter to gather the light from a 3.5 mm fiberbundle with 0.5 NA. Light incident to illumination blade input 118enters the illumination blade through generally cylindrical, activeinput zone 120 and travels through active input transition 122 to agenerally rectangular active retractor neck 124 and through outputtransition 126 to output blade 125 which contains active output zones127 through 131 and active output end 133. Retractor neck 124 isgenerally rectangular and is generally square near input transition 122and the neck configuration varies to a rectangular cross section nearoutput transition 126. Output blade 125 has a generally high aspectratio rectangular cross-section resulting in a generally wide and thinblade. Each zone is arranged to have an output surface area larger thanthe input surface area, thereby reducing the temperature per unit outputarea.

In the illustrated configuration illumination blade 109 includes atleast one dead zone, dead zone 122D, generally surrounding inputtransition 122. One or more dead zones at or near the output of theillumination blade provide locations to for engagement elements such astabs to permit stable engagement of the illumination blade to theretractor. This stable engagement supports the maintenance of an air gapsuch as air gap 121 adjacent to all active zones of the illuminationblade as illustrated in FIG. 13. Neck zone 124 ends with dimension 132adjacent to output transition 126 which extends to dimension 134 at theoutput zones. The changing dimensions result in dead zones 126D and 126Eadjacent to output transition 126. These dead zones are suitablelocations for mounting tabs 114 to minimize any effects of theengagement elements on the light path.

To minimize stresses on the light input and or stresses exerted by thelight input on the illumination blade, the engagement elements arealigned to form an engagement axis such as engagement axis 136 which isparallel to light input axis 138.

Output zones 127, 128, 129, 130 and 131 have similar configurations withdifferent dimensions. Referring to the detailed view of FIG. 14, thecharacteristics of output zone 127 are illustrated. Each output zone isformed of parallel prism shapes with a primary surface or facet such aprimary facet 140 with a length 140L and a secondary surface or facetsuch as secondary facet 142 having a length 142L. The facets areoriented relative to plane 143 which is parallel to and maintained at athickness or depth 144 from rear surface 145. In the illustratedconfiguration, all output zones have the same depth 144 from the rearsurface.

The primary facets of each output zone are formed at a primary angle 146from plane 143. Secondary facets such as facet 142 form a secondaryangle 147 relative to primary facets such as primary facet 140. In theillustrated configuration, output zone 127 has primary facet 140 with alength 140L of 0.45 mm at primary angle of 27° and secondary facet 142with a length 142L of 0.23 mm at secondary angle 88°. Output zone 128has primary facet 140 with a length 140L of 0.55 mm at primary angle of26° and secondary facet 142 with a length 142L of 0.24 mm at secondaryangle 66°. Output zone 129 has primary facet 140 with a length 140L of0.53 mm at primary angle of 20° and secondary facet 142 with a length142L of 0.18 mm at secondary angle 72°. Output zone 130 has primaryfacet 140 with a length 140L of 0.55 mm at primary angle of 26° andsecondary facet 142 with a length 142L of 0.24 mm at secondary angle66°. Output zone 131 has primary facet 140 with a length 140L of 0.54 mmat primary angle of 27° and secondary facet 142 with a length 142L of0.24 mm at secondary angle 68°.

Output end 133 is the final active zone in the illumination blade and isillustrated in detail in FIG. 14. Rear reflector 148 forms angle 149relative to front surface 150. Front surface 150 is parallel to rearsurface 145. Terminal facet 151 forms angle 152 relative to frontsurface 150. In the illustrated configuration, angle 149 is 32° andangle 152 is 95°.

Other suitable configurations of output structures may be adopted in oneor more output zones. For example, output zones 127 and 128 might adopta concave curve down and output zone 129 might remain generallyhorizontal and output zones 130 and 131 might adopt a concave curve up.Alternatively, the plane at the inside of the output structures, plane143 might be a spherical section with a large radius of curvature. Plane143 may also adopt sinusoidal or other complex geometries. Thegeometries may be applied in both the horizontal and the verticaldirection to form compound surfaces.

In other configurations, output zones may provide illumination at two ormore levels throughout a surgical site. For example, output zones 127and 128 might cooperate to illuminate a first surgical area and outputzones 129 and 130 may cooperatively illuminate a second surgical areaand output zone 131 and output end 133 may illuminate a third surgicalarea. This configuration eliminates the need to reorient theillumination elements during a surgical procedure.

FIG. 16 illustrates COP laryngoscope illuminator 154 in use on a patient155. Laryngoscope 154 includes a handle 156 and a blade 157. The handle156 allows for grasping the laryngoscope 154. The blade 157 is rigid andis attached to and extending from the handle. The blade is formed ofcyclo olefin polymer that acts as a waveguide and further includes anillumination source. Blade 157 is for inserting into mouth 158 of apatient to allow viewing of a portion of the mouth, the pharynx, and thelarynx of the patient 155. Blade 157 is used to depress tongue 159 andmandible in order to prevent the tongue 159 of the patient 155 fromobstructing the view of the medical professional during examination.When the illumination source is illuminated, electromagnetic waves(light) are able to propagate through blade 157 and illuminate the mouthand trachea of the patient.

FIG. 17 illustrates the laryngoscope 154 of the laryngoscopeillumination system in further detail. The laryngoscope 154 includes ahandle 156 and a blade 157. Blade 157 is formed of cyclo olefin polymerthat acts as a waveguide. Blade 157 may have an illumination sourcedisposed therein. The illumination source disposed within the bladecomprises one or more LEDs 161 (light emitting diodes), battery 162, aconductor 163 electrically connecting the battery and the LED, and anLED control circuit 164 and switch 165. The LED is preferably awhite-light LED, which provides a bright, white light. The battery maybe provided in any form, but is preferably a lithium ion polymerbattery. Blade 157 may also be detachable from the handle anddisposable. The illumination source is in optical communication with theblade. When the illumination source is illuminated, light from theillumination source propagates through the blade illuminating predefinedareas adjacent to the blade.

FIG. 18 illustrates an alternate laryngoscope illumination system withthe illumination source in the handle of the laryngoscope 154. Thelaryngoscope 154 includes a handle 156 and a blade 157. Blade 157 isformed of cyclo olefin polymer and performs as a waveguide. Handle 156has an illumination source disposed therein. The illumination sourcedisposed within the handle comprises one or more LEDs 161 (lightemitting diodes), battery 162, a conductor 163 electrically connectingthe battery 162 and the LED 161, an LED control circuit 164, a switch165 and an optical fiber 166 in optical communication between the LED161 and the blade 157 for conducting light output 167 from the LED 161to the blade 157.

The light output 167 of the optical fiber travels to one or more lightdirecting surfaces such as surface 168 where it is directed towardoutput optical structures 169 on any suitable surface of the blade.Output optical structures 169 may direct illumination to particularanatomical areas through refraction while minimizing reflection thatcontributes to loss of light. The LED is preferably a white-light LED,which provides a bright, white light. The battery may be provided in anyform, but is preferably a lithium ion polymer battery. The optical fiber166 is secured in a channel provided in the laryngoscope 154. LED 161may be positioned in closer proximity to blade 157 such that light fromLED 161 is captured directly by blade 157, perhaps using opticalstructures on the light input portion of blade 157 that efficientlycapture light from LED 161, thereby obviating the need for optical fiber166. The handle 156 of this laryngoscope may serve as a heat sink fordissipating the heat generated by the LED, and additional heat sinksstructures may be added. The handle may also be manufactured andprovided separately from the blade of the laryngoscope 154. This way,the blade 157 may be packaged separately from the handle to enabledisposable use of the blade 157 with a non-disposable handle 156. Whenthe illumination source is illuminated, light from the illuminationsource propagates through the optical fiber to the blade illuminatingthe blade 157. This in turn can illuminate the mouth and trachea of apatient.

Cavity illuminator 172 of FIG. 19 includes a COP waveguide insert 174attached to blade 175. The waveguide insert may be attached to the bladesurface, e.g., with a suitable adhesive or other attachment means, ormay be inserted into a channel formed in the blade to receive and holdthe insert. The blade and handle may be separate pieces or integrated asa single device. In this embodiment, light from optical fiber 166injects light into waveguide insert 174, said light traveling along thewaveguide insert to exit at one or more optical output structurespositioned at one or more designated areas of the waveguide insert.Optical fiber 166 may be replaced by any other suitable light conduit,such as a rigid or flexible light pipe or waveguide.

Referring now to FIGS. 20 and 21, cavity illumination system 178includes COP waveguide insert 179, the waveguide insert having an inputconnector 180 to couple light into the waveguide insert from an externallight source, such as a fiber optic cable connected to any suitablelight source such as a xenon or tungsten light source. Waveguide insert179 may engage a channel 175 c in the blade. The channel is designed toengage the insert. The waveguide insert is formed of cyclo olefinpolymer. The waveguide may be made to be single use disposable or madeto be suitable for multiple uses. The light source contained in theblade injects light into the waveguide insert, said light then iscontained in the waveguide and travels to output optical structures inthe waveguide insert that direct light to particular anatomic areas.

Waveguide insert 179 as shown in FIG. 22 may include output opticalstructures such as structures 182 in one or more suitable locations todirect light 184 to any appropriate anatomical areas. Output opticalstructures 182, here, stair stepped facets such as facet 182F, running aportion of the length of the top surface 186T of the waveguide insert,each of facets 182F causing a portion of the light 184 to exit thewaveguide insert in a predetermined direction while minimizing lightlost due to reflection at these structures in order to maintain hightransmission efficiency. If the output optical structures abruptly endat an end face, light will shine out of this end face. However, thelight that exits the end face may not serve as useful illumination and,hence, may be considered lost light that lessens the efficiency of thewaveguide insert. To improve efficiency, one or more optical structures187 may be arranged on bottom surface 186B of to direct light out of thecorresponding top surface 186T, which may have microstructured opticalcomponents to diffuse or further direct the output light 188. Combiningthe bottom face output optical output structures 187 with the top faceoutput optical structures 182 increases the transmission efficiency ofthe waveguide insert.

FIG. 23 is a side view of a COP speculum illumination system in a closedor insert position. Gynecological speculum 190 includes a first handle191, a second handle 192, an upper blade 193 and lower blade 194. Theupper blade 193 and lower blade 194 are formed of cyclo olefin polymerthat functions as a waveguide. Each blade may engage an illuminationsource or have an illumination source disposed therein. The illuminationsource disposed within the blades comprises one or more LEDs 196 (lightemitting diodes), battery 197, a conductor 198 electrically connectingthe battery and the LED, and an LED control circuit 199 and switch 200.The LEDs such as LED 196 are preferably a white-light LED, whichprovides a bright, white light. Battery 197 may be provided in any form,but is preferably a lithium ion polymer battery. The blades may also bedetachable from the handle and disposable. The illumination source is inoptical communication with the respective blade. When the illuminationsource is illuminated, light from the illumination source propagatesthrough the blade providing illumination from appropriate areas of theblade.

Referring now to FIG. 24, handles 191 and 192 are closed to separateblades 193 and 194. In this orientation, blades 193 and 194 may directlight into any cavity in which the device is engaged. Any suitablestructure, or structures such as coating 201, facets 202 and or microoptical structures 203 may be incorporated into blades 193 and or 194 tocontrol and direct illumination, however, such structure or structuresmust be specifically designed to maximize light transmission efficiencyand minimize light loss and must be specifically designed to directlight to specific anatomic structures. For example, structures 202 maydesigned to direct more diffuse light to illuminate a substantialportion of the vaginal wall, or may be designed to direct more focusedlight to illuminate the cervix at the end of the vaginal cavity, or maybe designed to provide both types of illumination. Single or multiplerefractive and/or reflective structures, which may be combined withmicrostructured optical components, may be used to maximize lighttransmission efficiency to allow lower power light sources to be used,thereby reducing heat generation and the need to provide cumbersome heatmanagement devices and methods.

FIG. 25 illustrates an alternate COP cavity illumination system with theillumination source in first handle 204 and second handle 206 of thespeculum 210. The speculum 210 includes a first handle 204 engagingupper blade 205, and a second handle 206 engaging lower blade 207. Theupper and lower blades 205 and 207 are formed of cyclo olefin polymerthat functions as a waveguide. Handles 204 and 206 have an illuminationsource disposed therein. The illumination source disposed within one orboth handles comprises one or more LEDs such as LED 211 (light emittingdiodes), battery 212, a conductor 213 electrically connecting thebattery and the LED, an LED control circuit 214, a switch 215 and anoptical fiber 216 in optical communication between the LED and a bladesuch as upper blade 205. The optical output of the optical fiber 216travels through the blade illuminating the anatomical area(s) ofinterest. The LED is preferably a white-light LED, which provides abright, white light. The battery may be provided in any form, but ispreferably a lithium ion polymer battery. The optical fiber is securedin a channel provided in the speculum. The handles of this speculum mayserve as a heat sink for dissipating the heat generated by the LED, andadditional heat sinks structures may be added. The handles may also bemanufactured and provided separately from the blades of the speculum.This way, the blades may be packaged separately from the handle toenable disposable use of the blade with a non-disposable handle. Whenthe illumination source is illuminated, light from the illuminationsource propagates through the optical fiber to the blades illuminatingthe upper blade and lower blade. This in turn can illuminate the vaginalcavity or any other cavity of a patient.

Speculums with metal blades continue to be used. If a metal speculum ispreferred, then a disposable waveguide insert, similar to that shown inFIG. 19 or FIG. 20, may be provided.

Speculum 220 of FIG. 26 may be a disposable speculum comprised of a COPilluminating bottom blade 221 (waveguide blade) and a non-illuminatingtop blade 222. Waveguide blade 221 has an input connector 224 for asuitable light source, such as a fiber optic cable 225 connected to anexternal xenon light source 226. Light 228 enters the connector portionof the waveguide blade and travels up the handle portion to a lightdirecting structure 230, which directs the light 90 degrees toward theoutput optical structures 231 and 232 located along the bottom bladeportion.

If COP blade 221 has a solid cross-section as shown in FIG. 26A, outputoptical structures such as structures 231 and 232 may extend the fullwidth 234 of blade 221 as well. If the COP blade has a concave orcup-shaped cross-section as shown in FIG. 26B, separate output opticalstructures may be located on edge faces 235 and 236 as well as onconcave surface 237. The output optical structures direct light tospecific anatomic areas and such light may be more diffuse, morefocused, or a combination of each.

Cavity illumination system 238 of FIG. 27 may include two COP waveguideblades, 221 and 239. The bottom waveguide blade 221 is as described forFIG. 26. Top waveguide blade 239 may include a connector 240 for aseparate light source or both the top and bottom waveguide blades may beconnected to the same light source 241. Top waveguide blade 239 may notneed internal light directing structures, such as structure 230 in blade221, because its normal geometry may provide suitable reflectingsurfaces for directing light 242 toward the output optical structures239 a and 239 b. Top waveguide blade may have a similar output opticalstructure as the bottom waveguide blade. Together, the two bladesprovide even illumination of the entire cavity wall. Alternatively, eachblade may have different output optical characteristics to providecomplimentary illumination, each blade illuminating different areas oranatomy or providing illumination energy of different wavelengths.

FIG. 28 illustrates a side view of a COP illuminating anoscope waveguide250 with a proximal end 251 and a distal end 252 that is inserted into apatient's natural cavity such as the anal cavity. The anoscope waveguide253 may also be used as a general speculum. The anoscope waveguide isformed of cyclo olefin polymer. It may also include an input connector254 that serves to conduct light into the waveguide such that light isconducted around the entire circumference 255 of the waveguide tube.Output optical structures 256 are typically placed near the distal endon the inside wall 257 along all or a portion of circumference 255.Output optical structures placed on the end face 258 or outside wall 259might cause irritation to the cavity walls during insertion. If outputoptical structures are required on end face 258 or outside wall 259, anysuitable coating or material may be used to lessen the irritation to thepatients body tissue during insertion of the waveguide. The outputoptical structures provide even illumination of the entire cavity wall.A reflective or prismatic surface may also be created on the proximalend face to send mis-reflected light rays back toward the distal outputoptical structures.

Referring now to FIG. 29 shows an example of a light directing structurethat contributes to light distribution around circumference 255. Lightentering input connector 254 may be directed by a light controlstructure, such as structure 260, which splits the incoming light andsends it down into the waveguide tube wall at an angle ensuringcircumferential light distribution.

Referring now to FIG. 30, optical waveguide 270 may include an alternatelight coupling apparatus such as coupling 271. Coupling 271 may providemechanical support and optical conduit between optical input 272 andwaveguide 270.

Distal end 276 as shown in FIG. 31 includes one of more vertical facetssuch as facet 276F within the distal end to disrupt the light spiralingwithin the waveguide. Also shown are structures such as structure 278 onthe end face of the cannula which serve to direct light as it exits theend face. Shown are convex lenses, but concave lenses or other opticalstructures (e.g., stamped foil diffuser) may be employed depending onthe desired light control. Stepped facets such as facets 279 and 281 areshown on the outside tube wall. The “riser” section, risers 279R and281R respectively, of the stepped facet is angled to cause the light toexit and as a result the waveguide slides against tissue withoutdamaging the tissue. The angle is generally obtuse relative to theadjacent distal surface. Steps may be uniform or non-uniform as shown(second step from end is smaller than the first or third step) dependingon the light directional control desired. The steps may be designed todirect light substantially inwards and or toward the bottom of the tubeor some distance from the bottom of the tube, or they may be designed todirect light toward the outside of the tube, or any suitablecombination. The facets such as facets 87 and 89 may be each designed todirect light at different angles away from the waveguide and or may bedesigned to provide different beam spreads from each facet, e.g., byusing different micro-structure diffusers on each facet face.

Facets may be used on the inside surface of the COP waveguide, but ifwaveguide material is removed to form the facets, the shape of thewaveguide may be changed to maintain the internal diameter of the boregenerally constant to prevent formation of a gap is between thewaveguide and a dilator tube used to insert the waveguide into the body.Said gap may trap tissue, thereby damaging it during insertion into thebody or causing the waveguide to be difficult to insert. Thus the outerwall of the waveguide may appear to narrow to close this gap and preventthe problems noted.

Referring now to FIGS. 32, 33 and 34, applied light energy 282 may bebifurcated to send light into wall 284 of COP waveguide or tube 286.Light input 288 may be split in input coupling 290.

The bifurcated ends 290A and 290B of input 288 preferably enter tubewall 284 at an angle 291 to start directing light around the tube wall.Alternatively, the bifurcated ends 290A and 290B may each enter tubewall 284 at different angles to further control light distribution. Thebifurcated ends may enter the tube wall orthogonally, but this mayrequire a prism structure in the wall placed between the input and theoutput with the apex of the prism pointed at the input. The prismstructure directs the light around the tube wall. A vertical prismstructure, prism 292 is shown with apex 292A of the prism pointed intoward the center of the tube. Prism structure 292 may direct a portionof the input light back underneath the inputs and contributes todirecting light all the way around the tube wall. The position, angleand size of this prism relative to the input bifurcated end determineshow much light continues in the tube wall in its primary direction andhow much light is reflected in the opposite direction in the tube wall.

Additional vertical prism structures or light disruption structures maybe placed toward the bottom of the tube on the outside tube wall asshown in FIGS. 32, 33 and 34. One or more light extraction structures294, shown as circumferential grooves cut into the outside wall of thetube, may also be included to optimize the illumination provided belowwaveguide 286. Light 287 traveling circumferentially in the tube wallwill not strike the light extraction structures 294 with sufficientangle to exit waveguide 286. Thus, vertical prism 296 or lightdisruption structures such as disruption prisms 296A, 296B, 296C and296D may be necessary to redirect the light so that the light rays 287will strike light extraction structures 294 and exit the tube wall toprovide illumination. As shown in FIG. 34, vertical prism structuressuch as 296A and 296B have different depths around the circumference inorder to affect substantially all of the light rays travelingcircumferentially in the tube wall. Vertical prisms of constant depthwould not affect substantially all of the light rays.

FIG. 33 also illustrates how a COP half-tube may be formed to provideillumination. At least one COP half-tube illuminator may be attached tothe end of at least one arm of a frame, such as that used in Adson,Williams or McCulloch retractors. Such frames typically include twoarms, but some frames have more than two arms. The arms of the frame arethen moved apart to create a surgical workspace, with the at least onehalf-tube illuminator providing illumination of said space. One or morehalf-tube illuminators may also be provided with an extension thatpreferably is in contact with the opposite half tube and that serves toprevent tissue from filling in the gap created when the half tubes areseparated. Tissue may enter this gap and interfere with surgery, so theextension helps reduce that issue.

FIGS. 35 and 36 illustrate alternative configurations of an illuminationwaveguide. Proximal reflecting structures such as proximal structure 297and proximal structure 298 may provide more complete control of thelight within the waveguide with an associated weakening of thestructure.

Referring now to FIGS. 37 and 38, cross-sections 299 and 300 illustrateadditional alternate light extraction structures of the distal end of anillumination waveguide. As shown with respect to FIG. 31 above, depth301 of light extraction structures such as structures 302 and 304increases relative to the distance from the light input in order toextract most of the light and send the light out the inner tube wall 305toward the bottom or distal end 306 of the tube. The light that remainsin the tube wall below the extraction structures exits the bottom edge307, which may be flat or may have additional optical structures, e.g.,a curved lens or a pattern of light diffusing structures such asstructures 278 of FIG. 31. In FIG. 37, the distal 5-10 mm of the tubewall, window 308, have no structures to enable this surface to operateas a window to the surrounding tissues to improve visualization of thesurgical space. As illustrated in FIG. 37, light extraction structures302 are formed of adjacent facets such as facets 302A, 302B, 302C and302D forming angles 303 between adjacent facets. In this illustrationangles 303 are obtuse.

As illustrated in FIG. 38, light extraction structures 304 are formed ofadjacent facets such as facets 304A, 304B, 304C and 304D forming angles309 between adjacent facets. In this illustration angles 309 are acute.Any suitable angle may be used.

It has been demonstrated that a clear waveguide cannula providesimproved visualization of the entire surgical workspace because thesurgeon can see the layers of tissue through the walls, therebyenhancing the surgeon's sense of depth and position, which are difficultto determine in an opaque cannula. Light exiting the side walls at theareas of tissue contact, due to changes in total internal reflection atthese contact areas, serves to illuminate these tissues making them morevisible than if a non-illuminated, non-waveguide clear plastic cannulais used. Alternatively, extraction structures 302 or 304 may extend allthe way down to bottom edge 307.

Referring now to FIGS. 39-42, light input connector 312C surrounds lightinput cylinder 312 which may be divided into multiple input arms such asarms 311 and 313 that then direct light into illumination waveguide 310.Input arms 311 and 313 may assume any suitable shape and cross-sectionsdepending on the optical design goals, such as the multi-radius armswith rectangular cross-section shown or straight sections (no radius) orangle rotators, etc. Also shown is a clamp flange holder 314 that servesto support input connector 312C and arms as well as providing a standardlight connector 312C over input cylinder 312 (e.g., an ACMI or WOLFconnector) and a flange 314F at the top for attaching a clamp used tohold the entire structure in place once it is positioned relative to asurgical site in a body. A shelf or other similar light blockingstructures may be added to the holder, extending over the input arms andor the upper tube edge as needed to help block any light that may escapethese structures that might shine up into the user's eyes.Circumferential light extraction structures 316 are shown at the bottom,distal end 318, of the tube. In the section view of FIG. 40, verticallight disruption structures or facets 276F are shown on the inside wallof the tube.

Illuminated cannula 310 of FIG. 39 includes clamp adapter 314 that alsosupport light coupling 312C for introducing light energy into cannula310. The relative orientation of the clamp adapter and the lightcoupling as shown enables the clamp adapter to operate as a shield toprevent any misdirected light shining into the eyes of anyone lookinginto bore 310B of the cannula, but the clamp adapter and light couplingmay adopt any suitable orientation.

FIG. 40 illustrates vertical facets 276F within the distal end fordisrupting the light spiraling within the waveguide. Circumferentiallight extraction structures 316 may include stepped facets such asfacets 316F and risers such as riser 316R on the outside tube wall 310W.The “riser” section of the stepped facet section 316R is angled so thatit may slide against tissue without damaging the tissue. Steps may beuniform or non-uniform depending on the light directional controldesired. The steps may be designed to direct light substantially inwardsand toward the bottom of the tube or some distance from the bottom ofthe tube, or they may be designed to direct light toward the outside ofthe tube, or both.

Circumferential light extraction structures such as structures 316 maybe facets or may be other geometries, such as parabolas. Circumferentiallight extraction structures coupled with light directing structures thatprovide circumferentially distributed light to the extraction structuresprovide circumferential illumination. Since tools entering the interiorof the tube now have light shining on them from all sides, the tools donot cast any shadows within the cone of illumination emitted by thecannula. The circumferential illumination from a cylindrical waveguidecreates a generally uniform cone of light that minimizes shadows, e.g.,from instruments, creating substantially shadowless illumination in thesurgical field below the tubular waveguide.

COP Cannula 310 of FIGS. 41 and 42 is illustrated without clampflange/holder 314 in place. Input arms 311 and 313 above are offsetabove proximal surface 319 by a distance 320 and end in angled reflectorsurface 321 that partially extends down distance 322 into the tube wall.The offset controls the light entering waveguide 310 and restricts lightentering to input structure 323. Reflector surface 321 serves to directlight orthogonally from the horizontal input and down into the tubewall, also causing the light to spread around the circumference of thetube wall by the time the light reaches the distal or lower part of thetube. Reflector surfaces such as surface 321 may be a flat surface, anarced surface, or a series of interconnected surfaces and may also endat the top of the tube wall. Reflector surface 321 may be treated, e.g.,a reflective or metallized coating or an applied reflective film, toenhance reflection.

Air gaps may be used to isolate the light-conducting pathway in anysuitable connector. Waveguide 310 of FIG. 43 includes male connector324C that has been integrated with waveguide tube wall 310W via bracket325. This allows connector 324C to be molded with the waveguide and notattached as a separate part, such as standard light connector 312C shownin FIG. 39. A separate connector introduces tolerance concerns into thesystem that may result in reduced coupling efficiency between a fiberoptic cable output and waveguide input 326 because the two parts may notbe aligned correctly. Molding the connector and the waveguide input asone piece substantially reduces the chance of misalignment and therebyincreases coupling efficiency.

FIG. 44 is a front view looking into input 326 of connector 324C. Airgaps 327 are maintained around waveguide input 326 to isolate thelight-conducting pathway. One or more small zones of contact such ascontact zone 327C may be maintained, essentially bridging connector 324Cand input 326 with a small amount of material, to add strength andstability to the system while resulting in minimum light loss in thecontact zone.

COP Waveguide 330 of FIGS. 45 and 46 may be split open during surgery topermit greater access to the surgical field. Waveguide 330 is formed ofcyclo olefin polymer. Light input channels 331 and 333 may be split andfed through a “Y”. Waveguide 330 is fully split front and back from thetop to about ½-⅔ of tube by slots 334 and 336. Alternatively, awaveguide may be split all the way to lower portion 330L. Lower portion330L is scored inside and out with scoring such as score 337. Thescoring operates to redirect light that may be trapped circling thetube. Bottom element 340 may also be a COP element and is pre-split inhalf along edge 341 and may be glued or otherwise secured in a waveguidesuch as COP waveguide 330. The generally planar shape of element 340permits viewing through bottom element 340 and allows light to shinethrough. Alternatively, element 340 may also adopt any other suitablegeometry such as rounded to form a lens. Because of the interface withthe tube along edge 342 very little light is conducted into element 340.Hole 343 enables a surgical screw or other suitable connector to engagethrough bottom element 340 of waveguide 330 to a surgical site.Splitting waveguide 330 and bottom 340 frees the waveguide elements froma connector through hole 343, and permits the waveguide elements to beremoved from the surgical site. While at least one light extractionstructure is preferably located in lower portion 330L on each tube half,the at least one extraction structure may be located on only one half ormay be located further up the tube, e.g., near the end of split 334 andor split 336.

COP waveguide 344 in FIG. 47 has reflector face 345 extending down theside of waveguide 344 opposite light input 346, effectively removingmaterial 347. Extended reflector face 345 serves to direct lightcircumferentially around the tube wall. This opens up the waveguide toprovide improved access to the surgical space. In addition, it offersthe opportunity to replace removed material 347 with more durablematerial to improve strength and or provide a second clamp flange holderand or to provide mounting for other devices, such as a CCD camera.

Illuminated COP retractors such as cannula, waveguides, tubes and orsheaths may also benefit from extendable skirts or segments to preventtissue encroaching on a surgical site. The extendable elements may alsoinclude interface surfaces to introduce light into the elements toenhance surgical site illumination and or provide off axis illuminationto enhance shadows for better depth perception and tissuediscrimination.

The illuminated COP retractors as discussed above may also be madeextendable or telescoping to enable a varying depths of surgery with asingle thus device minimizing hospital inventory. The illuminatingcannulas discussed may also be formed as an illuminating drill guide,either as a tube or as two half tubes, that may be used to hold andguide drill or burr tip while also providing illumination of the areabeing worked on.

A COP illuminator may be characterized as having a light input portion,a light conducting portion and a light output portion. The light inputportion of the COP illuminator receives light from an external lightsource. Such a light source may be an external light box, e.g., a xenonlight box, to which one end of a fiber optic light guide cable isattached to conduct light to the surgical field. In this instance, theother end of the fiber optic cable would be the source of light for theblade insert illuminator, for example, by employing a mating connectoron the illuminator so that it may connect to the fiber optic cable. Thelight input portion may also include a tab, finger or other projectionextending from a dead zone to engage the retractor blade at the top orhandle end, the projection may be permanently integrated or temporarilyattached.

The light conducting portion of the COP illuminator typically isresponsible for conducting light from the light input section to thelight output section. It may be simply a section of optical materialdesigned to support total internal reflection that is integral with thelight input and light output portions. Surface treatment, e.g.,polishing or reflective coating, and the continuous air gap may be usedto support total internal reflection.

The light output portion of the COP illuminator may contain any suitablenumber of output zones of generally similar depth, each zone havingspecially designed output optical structures that control and directlight to escape the illuminator to shine onto a predetermined area ofinterest or to have a predetermined shape or footprint. Such structuresmay be molded or cut into the light output zones. In someconfigurations, two to eight output zones are provided.

A cyclo olefin polymer air gap retractor illumination system includesany suitable retractor such as a McCulloch with a channel in the bladeto accommodate an air gap illuminator. The COP illuminator has activeportions in which light passes and inactive or dead zones in which lightdoes not pass as a result of the configuration and orientation of theinput, output and surfaces of the illuminator. The illuminator is formedto have an air gap surrounding any active portion of the illuminatorextending from the light input to the light output portion. The deadzones may include elements to allow the illuminator to securely engagethe retractor. The light output portion of the illuminator may containany suitable number of output zones, each zone having specially designedoutput optical structures that control and direct light to escape theilluminator to shine onto a predetermined area of interest or to formone or more predetermined shapes or footprints.

A COP blade insert illuminator may comprise one or more illuminatorsections designed to engage a mating channel or channels formed in theblade. Blade insert illuminators may be characterized by having a lightinput portion, a light conducting portion and a light output portion.The blade illuminator may be oriented at any suitable position along theretractor blade channel. A COP blade illuminator may be adapted totemporarily or permanently attach to any other suitable surgicalinstrument such as for example, a Gelpi retractor.

The light input portion of a COP blade insert illuminator receives lightfrom an external light source. Such a light source may be an externallight box, e.g., a xenon light box, to which one end of a fiber opticlight guide cable is attached to conduct light to the surgical field. Inthis instance, the other end of the fiber optic cable would be thesource of light for the blade insert illuminator, for example, byemploying a mating connector on the illuminator so that it may connectto the fiber optic cable. The light input portion may include a shortsection of a light conducting material, such as for example, a suitableplastic or a fiber optic bundle, that is permanently integrated ortemporarily attached.

The light conducting portion of a COP blade insert illuminator typicallyis responsible for conducting light from the light input section to thelight output section. It may be simply a section of optical materialdesigned to support total internal reflection that is integral with thelight input and light output portions. Any suitable surface treatment,such as for example, polishing, reflective coating, anti-reflective (AR)coatings and or dielectric coatings may be used to support totalinternal reflection.

The light output portion of a COP blade insert illuminator containsspecially designed output optical structures that allow light to beextracted from the illuminator to shine onto a predetermined area ofinterest. Such structures may be molded into the light output portion orsuch structures may be applied, for example, as a film.

A COP blade insert illumination system may consist of a singleilluminator that contains the light input, light conducting and lightoutput portions in a simple, single device that acts as a waveguide.Such a system may also be comprised of different sections of illuminatorcomponents that attach together to form a complete system. In this case,there may be a light input section designed to receive light from alight source, one or more light conduit sections designed to conductlight from the light input section to a light output section, and alight output section containing the optical output structures that allowlight to escape and illuminate a predetermined area of interest, saidsections attaching together to form a complete system. Each section actsas a waveguide and may employ optical structures to polarize and orfilter the light energy entering or exiting the waveguide.

A COP blade insert illuminator must be designed and fabricated tomaximize light transfer from the light source or fiber optic input cableand minimize light loss from the waveguide in order to provide anefficient light transmission system. Efficiency is particularlyimportant for LED and other light sources, e.g., halogen or xenon lamps,because it directly determines the required brightness of the LED. Aninefficient waveguide experiences significant light loss, typically 60%of light may be lost from input to output. Such a light guide wouldrequire a high power LED to provide sufficient light. A high power LEDrequires a lot of power and generates significant heat, therebyrequiring large batteries and bulky and inconvenient heat sinkingdevices and methods that add to the size and increase the difficulty ofusing such a device. Other high power light sources often require noisyfans, which may disturb the medical personnel conducting a surgery ormedical exam. Lamps used in high power light sources have a limited lifetime, requiring frequent and expensive replacement, due to the need todrive the lamp at high power levels to generate enough light. Anefficient waveguide, one in which light loss is typically less than 30%,allows a much lower power LED or other light source to be used, therebysignificantly reducing or eliminating the need for special heat sinkingdevices and methods, reducing cost, and improving the usability of thedevice. The design of an efficient blade insert illumination waveguidemay involve special design of the light input portion of the waveguideto efficiently capture the incoming light, for example, by carefulselection of numerical apertures or using a lens, design and fabricationof the light reflecting walls of the light conducting portion of thewaveguide to maintain surface finish to maximize reflection and reducelight lost through refraction, the use of reflective or dampeningcoatings, the design of light directing optical structures that directthe light toward the light output optical structures while minimizinglight loss through refraction, and or the design of light output opticalstructures that maximize light exiting the waveguide through refraction,particularly refraction of light in certain directions, while minimizinglight lost through reflection.

While the preferred embodiments of the devices and methods have beendescribed in reference to the environment in which they were developed,they are merely illustrative of the principles of the inventions. Otherembodiments and configurations may be devised without departing from thespirit of the inventions and the scope of the appended claims.Additionally, while the above is a complete description of the preferredembodiments of the invention, various alternatives, modifications, andequivalents may be used. For example, many of the optical components aredisclosed as being formed from COP. One of skill in the art willappreciate that COC may also be used to form those components.Therefore, the above description should not be taken as limiting thescope of the invention which is defined by the appended claims.

What is claimed is:
 1. An illuminated medical system comprising: amedical instrument; and a light transmitting waveguide having a proximalregion and a distal region, the waveguide coupled to the medicalinstrument, wherein the waveguide is configured to conduct light fromthe proximal region to the distal region thereof, and the waveguideprojects the light from the distal region toward a target area, andwherein the waveguide is formed primarily of a cyclic olefin copolymeror a cyclic olefin polymer.
 2. The system of claim 1, wherein themedical instrument comprises one of a surgical retractor, alaryngoscope, a speculum, or an anoscope.
 3. The system of claim 1,wherein the waveguide is adjustably positionable relative to the medicalinstrument thereby allowing adjustment of the projected light onto thetarget area.
 4. The system of claim 1, wherein the waveguide furthercomprises one or more output optical structures disposed adjacent thedistal region thereof, the output optical structures configured todirect the light from the distal region of the waveguide to the targetarea.
 5. The system of claim 4, wherein the output optical structurescomprise one or more facets.
 6. The system of claim 1, wherein thewaveguide comprises a tubular body.
 7. The system of claim 1, whereinthe waveguide comprises an elongate blade.
 8. The system of claim 1,wherein the waveguide comprises a half tubular body.
 9. The system ofclaim 1, further comprising: an illumination source that provides thelight; an illumination conduit optically coupled with the illuminationsource and the waveguide, the illumination conduit configured to conductlight from the illumination source to the waveguide; and an opticalcoupling coupled to the waveguide and the illumination conduit, theoptical coupling configured to optically couple the illumination conduitwith the waveguide so that the light may pass therebetween, and whereinthe optical coupling also releasably holds the illumination conduit andthe waveguide together.
 10. The system of claim 1, wherein the waveguidehas a specific gravity less than polycarbonate or acrylic.
 11. Thesystem of claim 1, wherein the waveguide has a water absorption rateless than polycarbonate or acrylic.
 12. The system of claim 11, whereinthe water absorption rate of the waveguide is less than 0.01%.
 13. Thesystem of claim 1, wherein the waveguide transmits light with greaterefficiency than polycarbonate or with efficiency greater than or equalto acrylic.
 14. The system of claim 13, wherein the light transmittanceof the waveguide is 90% or greater.
 15. The system of claim 1, whereinthe waveguide has a refractive index greater than acrylic.
 16. Thesystem of claim 15, wherein the refractive index of the waveguide isgreater than 1.49.
 17. The system of claim 1, wherein the waveguide hasa glass transition temperature higher than that of polycarbonate. 18.The system of claim 17, wherein the glass transition temperature of thewaveguide is greater than or equal to 105° C.
 19. The system of claim 1,wherein the waveguide is biocompatible.
 20. An illuminated medicalsystem comprising: a medical instrument; and a light transmittingilluminator having a proximal region and a distal region, theilluminator coupled to the medical instrument, wherein the illuminatoris configured to conduct light from the proximal region to the distalregion thereof, and the illuminator comprises a light input portion, alight conducting portion, and a light output portion, wherein the lightoutput portion projects the light from the distal region of theilluminator towards a target area, and wherein the light conductingportion is formed primarily of a cyclic olefin copolymer or a cyclicolefin polymer.
 21. The system of claim 20, wherein the medicalinstrument comprises one of a surgical retractor, laryngoscope, aspeculum, or an anoscope.
 22. The system of claim 20, the light outputportion is adjustably positionable relative to the medical instrumentthereby allowing adjustment of the projected light onto the target area.23. The system of claim 20, wherein the light output portion comprisesone or more output optical structures disposed adjacent the distalregion thereof, the output optical structures configured to direct thelight from the light output portion to the target area.
 24. The systemof claim 23, wherein the output optical structures comprise one or morefacets.
 25. The system of claim 20, wherein the light conducting portioncomprises a tubular body.
 26. The system of claim 20, wherein the lightconducting portion comprises an elongate blade.
 27. The system of claim20, wherein the light conducting portion comprises a half tubular body.28. The system of claim 20, further comprising: an illumination sourcethat provides the light; and an illumination conduit optically coupledwith the light input portion and the illumination source, theillumination conduit configured to conduct light from the illuminationsource to the light input portion.
 29. A method for illuminating amedical work space, said method comprising: providing a medicalinstrument coupled to a light transmitting waveguide; advancing themedical instrument and the waveguide toward the work space; illuminatingthe work space with light from the waveguide, wherein the light passesfrom a proximal portion of the waveguide to a distal portion of thewaveguide, and wherein the waveguide is formed primarily of a cyclicolefin copolymer or a cyclic olefin polymer.
 30. The method of claim 29,wherein the medical instrument comprises one of a surgical retractor, alaryngoscope, a speculum, or an anoscope.
 31. The method of claim 29,wherein advancing the medical instrument and the waveguide furthercomprises positioning the medical instrument in a patient and retractingtissue.
 32. The method of claim 29, wherein advancing the medicalinstrument and the waveguide comprises positioning the medicalinstrument and the waveguide in a body orifice.
 33. The method of claim29, wherein advancing the medical instrument and the waveguide comprisespositioning the medical instrument and the waveguide into an incision.34. The method of claim 29, wherein the waveguide comprises a tubularbody having a central channel, and advancing the medical instrumentcomprises positioning the medical instrument through the centralchannel.
 35. The method of claim 29, wherein illuminating comprisesadjusting waveguide position relative to the medical instrument, therebyadjusting illumination of the work space.
 36. The method of claim 29,wherein illuminating comprises optically coupling the waveguide with anillumination source.